2009—2019 年重庆市涪陵区15 岁以下人群流感病原学监测结果分析

目的 了解重庆市涪陵区2009—2019年15岁以下人群流感病原学的流行趋势及特征,为今后的流感防控工作提供科学依据。方法 分析2009—2019年涪陵区流感网络监测实验室获得的15 岁以下人群流感样病例（Influenza-like illness,ILI）监测结果。结果 女性ILI病毒分离阳性率（14.53%）和男性阳性率（13.74%）无统计学意义（〖XC小五号.EPSP〗=0.98,P＞0.05）;初中生阳性率最高（23.94%）,其次是小学生（19.69%）、幼儿园儿童（17.10%）,散居儿童最低（7.64%）,差异有统计学意义（〖XC小五号.EPSP〗=238.82,P＜0.05）;各学龄段儿童之间流感病毒类型构成差异有统计学意义（〖XC小五号.EPSP〗=40.71,P＜0.05）;ILI病毒检测阳性率的季节规律呈单、双峰交替出现,2010 年、2014 年、2015 年流行高峰出现在夏季,其余年份流行高峰均在冬春季;主要病原学类型为季H3（36.63%）、B型Victoria系（28.60%）、新甲H1（27.98%）、B型Yamagata系（6.44%）,流感病毒阳性率与ILI病例数变化趋势相关（rs=0.312,P＜0.05）; ILI发病后采样时间、采样后送检时间对标本阳性率有显著影响。结论 涪陵区15岁以下人群流感流行处于上升趋势,流行高峰时间处于动态变化,近年来主要在冬春季;初中生和小学生ILI病毒检测阳性率高于学龄前儿童,提示冬春季要加强中小学校学生流感防控工作。     

强迫症患者认知功能与病期的关系

目的：探讨强迫症的认知功能障碍与病期的关系。方法：分别用韦氏记忆测验，数字划销测验和威斯康星卡片分类测验评估25例急性强迫症和36例慢性强迫症患者的记忆、注意和执行功能。结果：急性强迫症患者的记忆测验中记图和数字划销测验中第二阶段失误率显著性较慢性强迫症差，其余两组间记忆测验、划销测验和威斯康星卡片分类测验各量表分无显著性差异。结论：强迫症的认知功能与病期无明显相关。     

Sexual dysfunction in male and female patients with epilepsy: A study of 86 outpatients

Sexual dysfunction is a well-known complication of chronic somatic illness. Eighty-six consecutive epileptic outpatients, 38 men and 48 women, without accompanying disorders, were studied. The frequency and symptoms of sexual dysfunction were compared with results from previous studies using identical sexological methodology. The previous studies were of diabetic patients and healthy controls. Eight percent of the epileptic men reported a sexual dysfunction compared to 44% of the diabetics and 13% of the controls. Epileptic women, diabetic women, and controls showed no significant differences in sexual dysfunction (29%, 28%, and 25%, respectively). In both sexes, the sexual function measured by frequencies of coitus and masturbation was normal. Most patients had good control of epileptic attacks on a treatment of monotherapy. Hormonal status was generally within normal limits in both men and women; only a few minor differences were found and they showed no correlation with sexual dysfunction. Psychologically and socially the patients did not differ appreciably from normals, and they exhibited a high degree of disease acceptance. This study, using a biopsychosocial approach in understanding sexual dysfunctions, is in contrast with previous, mainly uncontrolled, studies of epileptic patients that reported high frequencies of hyposexuality in males. We conclude that epilepsy does not necessarily increase the risk of sexual dysfunction in male or female.     

基于关键规则分组优先提取策略的完备化算法及其实现

在分析现有的完备化策略的基础上提出了关键规则分组优先提取策略,介绍了基于此策略的完备化算法及其具体实现,初步探讨了策略的选择对于提高此类系统演算效率的重要作用。     

Thermoresponsive Reversible Unimer Micelles of Amphiphilic Fluorinated Copolymers

Amphiphilic fluorinated copolymers PEGMAx-co-FAy and TEGMAx-co-FAy are prepared by activators regenerated by electron transfer atom transfer radical polymerization (ARGET-ATRP). All polymers present a reversible thermoresponsive lower critical solution temperature-type behavior, and a cloud point temperature (T_c) in the range of 30–60 °C strictly dependent on the length of the oxyethylene side chain, the content of the hydrophobic counits, and the concentration of the solution. Combined small angle X-ray scattering (SAXS) and dynamic light scattering measurements are used to study the self-assembly behavior in water, organic solvents (tetrahydrofuran [THF] and dimethylformamide [DMF]), and a fluorinated solvent (hexafluorobenzene [HFB]). SAXS confirms the formation of compact-globular single-chain self-folded unimer micelles in water below T_c, which generally presents small hydrodynamic diameters (D_h ≤ 8 nm) as a result of the folding of the hydrophobic perfluorohexylethyl acrylate counits. The copolymers are also able to form reverse unimer micelle in HFB. The copolymers are not able to self-assemble in unimer micelles in THF or DMF solutions, in which they adopt conventional random coil conformations.     

Social HMOs and Other Capitated Arrangements for Children with Special Health Care Needs

Objective: Children with special health care needs are increasingly enrolling in managed care arrangements. However, existing managed care organizations, including traditional HMOs, are often poorly suited for caring for this population. In the adult health care area, new managed care entities, called Social HMOs (S/HMO) and Programs for the All-inclusive Care for the Elderly (PACE), have been created to integrate health and health-related services for chronically ill and disabled adults. We describe these models and assess their potential for serving children with special health care needs. Method: We reviewed the literature on managed care for children with special health care needs and evaluation findings from the S/HMO and PACE models for the elderly. Results: Evaluations of the S/HMO and PACE models have yielded mixed findings. Some of the more positive accomplishments include lower use and expenditures for long-term care services compared to other demonstration projects, greater integration of primary care physicians in decision making concerning long-term care, and improved management of transitions between care levels. On the negative side, start-up has been slow, prospective members have been hesitant to enroll, intermittent and sometimes frequent operating deficits have emerged, no discernible positive effects on health or social outcomes are apparent, and no significant overall savings have emerged. Conclusions: With mixed results so far, caution is required in applying these or similar models for vulnerable child populations. However, given the inadequacies of traditional managed care for this population, we believe experimentation with new models of care that integrate health and health-related services is important. Such experimentation should be fostered only to the extent that the models are carefully designed and then implemented in a manner that protects the interests of children with special health care needs.     

Relationship between severity,costs and claims of hospitalized patients using the Severity of Illness Index

The results of the prospective application of Horn's Severity of Illness Index in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.     

Termination of extracorporeal membrane oxygenation for cardiac support

The determination of when to stop extracorporeal membrane oxygenation (ECMO) rests upon demonstration of the return of adequate cardiac function to support vital organs and permit subsequent recovery. In general, patients with myocardial stun will recover function within several days. Factors that limit recovery include elevated end diastolic pressures leading to marginal myocardial perfusion, ongoing organ damage, massive anasarca, or progressive deterioration in lung function. Following a trial of slow weaning of ECMO support to condition the heart to take over the entire system flow requirements, decannulation can be accomplished in a standard fashion. When weaning is not successful and additional time does not lead to adequate recovery of cardiac function, physicians and nurses must be prepare to realistically advise families regarding such options as cardiac transplantation or withdrawal of support. It is critically important to provide an open and nonjudgmental environment for families to make these difficult decisions. The greatest difficulties involve ethical and emotional decisions that need to be made in a timely fashion to prevent undo burden on the patient when further ECMO support is futile.